If you were asked to describe a friend’s personality, you might describe them as generally being a creative type, or easy-going but nervous in groups. Basically, you’re trying to summarize the personal traits that make them who they are, how they think, or how they act. Sometimes these thought patterns or behaviors which make up a person’s personality can be harmful in the sense that they interfere with their day-to-day functioning in their personal life, at work, or in social settings. If this were the case, we would say that the individual has a Personality Disorder.
The DSM-V, or the Diagnostic and Statistical Manual for mental disorders, 5th edition, lists ten personality disorders that are split into three different ‘clusters’, referred to as clusters A, B, and C. These used to be under the category “Axis 2” but that way of organizing isn’t really used anymore. Cluster B includes Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder. These are important because all four of these have a genetic relationship with Mood Disorders like Depression and Bipolar Disorder, as well as Substance Use Disorders.
Someone with Antisocial Personality Disorder, which sounds like someone who doesn’t get along well with others – but in fact, it’s the opposite – can be charming and often use that to manipulate others for personal gain. These individuals disregard moral values and societal norms, have little empathy, and poor impulse control. This combination makes them willing to hurt others if it helps them, making them prone to aggressive and unlawful behavior, at times earning the label sociopath or psychopath. In fact, individuals with this disorder tend to be over-represented in prison populations and have higher rates of substance use. These individuals typically fail to show remorse or guilt and rarely accept responsibility for any of the harm that they cause others. This disorder is also unique in that individuals must be over 18 years old and have a history of conduct disorder in order to meet the diagnosis.
Borderline Personality Disorder is where individuals have unstable moods. They go from intense joy one minute to rage the next minute; this leads to intense, sometimes wonderful relationships that generally become dramatic and sour over time. This pattern is sometimes called stable instability because the only consistent thing is instability. These people often use a defense mechanism called splitting where people and important things, like a job, are either completely good or completely bad. In addition, people with borderline personality disorder are often terrified of abandonment and might even do extreme things like threaten suicide to keep someone from leaving them.
Next, there’s Histrionic Personality Disorder where the key feature is attention-seeking and excessive emotionality, which sometimes leads them to manipulate a situation to draw more attention to themselves. For example, they might act inappropriately flirtatious or tell overly dramatized stories to remain the center of attention. These behaviors result in superficial relationships with lots of acquaintances, but few, if any, deep connections with good friends, because people tend to view them as shallow, flighty, and egocentric.
The last one in this group is Narcissistic Personality Disorder which is characterized by individuals who have a grandiose self-image where they think that they are more attractive, more intelligent, and more talented than they are. Since they believe they’re so special, they expect to be treated as such, obsessively demanding the best of everything—wine, steaks, you name it. They also think that their ideas are inherently the best and that other people should understand this and support them.
Behind this mask of ultra-confidence lies a fragile self-esteem that’s vulnerable to the slightest criticism, with them lashing out if they feel slighted. These people typically come across to others as being pretentious, self-centered, and entitled. This is made worse by the fact that they lack empathy and are often oblivious to others’ feelings. These people are often exploitative of those around them, and will only get involved in situations that advance their personal agenda.
There is considerable overlap between personality disorders. For example, individuals with Borderline Personality Disorder might also meet the diagnostic criteria for Antisocial Personality Disorder, as well as Schizotypal Personality Disorder and Avoidant Personality Disorder, which are part of clusters A and C, respectively. In general, traditional psychoanalytic therapies are ineffective for Cluster B personality disorders, since people with this disorder often can’t handle the strong, negative emotions that come with challenges to one’s self-evaluation. Some specific treatments can work well, though. For example, Dialectical Behavioral Therapy, which targets specific thoughts and behaviors can be helpful for some individuals.